The association between abuse history in childhood and salivary rhythms of cortisol and DHEA in postmenopausal women

Abstract

A history of child abuse (CA) is associated with morbidity and mortality in adulthood, and one proposed mechanism is dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Therefore, we evaluated whether a history of physical and sexual CA was associated with daily rhythms of HPA hormones (cortisol and dehydroepiandrosterone (DHEA)) among postmenopausal women (mean age: 60.6 years). In 2013, 233 participants from the Nurses' Health Study II provided up to 5-timed saliva samples over the course of a day: immediately upon awakening, 45 min, 4 h, and 10 h after waking, and prior to going to sleep. Among these 233 participants, 217 provided ≥4 timed saliva samples. Assessment of physical and sexual CA history occurred in 2001 using the Revised Conflict Tactics Scale. Cumulative CA history was derived by combining reports of physical and sexual abuse prior to age 18. Piecewise linear mixed models compared diurnal rhythms of cortisol and DHEA between participants with none-to-moderate CA (n = 104, reference group) versus high-to-severe CA (n = 113). Models adjusted for characteristics at each saliva collection, health status, sleep quality, medications, and hormone use. Compared to those with none-to-moderate CA, women with high-to-severe CA had different diurnal rhythms in the early and evening hours, including blunted (less steep) early declines in DHEA (% difference (%D) = 10.7, 95 % Confidence Interval (CI) 4.3, 17.5), and steeper late declines in both cortisol and DHEA (cortisol %D = -2.5, 95 % CI -4.8, -0.1, and DHEA %D= -3.9, 95 % CI -6.0, -1.8). In conclusion, high-to-severe abuse history prior to age 18 was more strongly associated with differences in DHEA rather than cortisol, suggesting that early life abuse may be related to dysregulation of stress-response mechanisms later in life.

Keywords: Child abuse; Cortisol; Cortisol to DHEA ratio; DHEA; Postmenopausal.

Figure 1:

Diurnal rhythms by cumulative physical and sexual child abuse (CA) history. Dots represent predicted values from mixed models at the actual time of the saliva collection. Legends are provided within each figure.

Figure 2:

Diurnal rhythms of cumulative physical and sexual child abuse (CA) history and PTSD symptoms. Dots represent predicted values from mixed models at the actual time of the saliva collection. Legend: (1) blue represents none-moderate CA and <4 PTSD symptoms (n=97), (2) red represents non-moderate CA and ≥4 PTSD symptoms (n=16), (3) green represents high-severe CA and <4 PTSD symptoms (n=70), and (4) brown represents high-severe CA and ≥ 4 PTSD (n=34).